药物涂层球囊技术治疗冠脉病变研究进展
Advances in Drug-Coated Balloon Technology for the Treatment of Coronary Artery Lesions
摘要: 作为一项全新的治疗手段,药物球囊(drug-coated balloons, DCB)依照其独特的治疗理念,在解除冠状动脉管腔梗阻带来的供血不足的策略中应运而生。DCB对比血管支架在解除冠状动脉狭窄方面具备更多的优势。这种不存留植入物的技术可以改善晚期的血管支架失效的风险,并且使长期持续的抗血小板治疗疗程显著缩短,潜在性地减少相关的出血并发症。因此,DCB的应用领域也逐渐成为心血管疾病研究人员广泛探寻的方向。本文依据当前已有的相关领域研究进展与结论进行讨论与总结。
Abstract: As a new treatment, the drug-coated balloon (DCB), in accordance with its unique therapeutic con-cept, was developed as a strategy to relieve the lack of blood supply due to coronary artery lumen obstruction. DCB offers more advantages than stenting in relieving coronary artery stenosis. This implant-free technique improves the risk of late stent failure and allows for a significantly shorter course of long-term continuous antiplatelet therapy, potentially reducing the associated bleeding complications. As a result, the application of DCB is becoming a widely explored area of interest for cardiovascular disease researchers. This article discusses and summarizes the current research advances and findings in this area.
文章引用:吕焕然, 衣英凡, 迟润泽, 王正忠. 药物涂层球囊技术治疗冠脉病变研究进展[J]. 临床医学进展, 2023, 13(11): 17387-17395. https://doi.org/10.12677/ACM.2023.13112435

参考文献

[1] 刘炎, 蔡安平, 肖纯, 等. 早发冠状动脉粥样硬化性心脏病人群危险因素、病变特点及其预后[J]. 岭南心血管病杂志, 2019, 25(1): 19-23.
[2] 刘超, 高嘉良, 王阶. 冠心病细胞焦亡的分子机制及其新药靶点的研究进展[J]. 医学综述, 2021, 27(2): 246-252.
[3] Roth, G.A., Mensah, G.A., Johnson, C.O., et al. (2021) Global Burden of Cardio-vascular Diseases and Risk Factors, 1990-2019: Update from the GBD 2019 Study (vol 76, pg 2982, 2020). Journal of the American College of Cardiology, 77, 1958-1959.
[4] 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2022概要[J]. 中国循环杂志, 2023, 38(6): 583-612.
[5] 吴志刚, 王东方, 刘智慧. 介入治疗对老年冠状动脉粥样硬化性心脏病的疗效[J]. 中国卫生标准管理, 2021, 12(7): 76-79.
[6] Alfonso, F., Garcia-Guimaraes, M., Navarrete, G., et al. (2017) Drug-Eluting Balloons in Coronary Interventions: The Quiet Revolution? Expert Opinion on Drug Delivery, 14, 841-850. [Google Scholar] [CrossRef] [PubMed]
[7] Rosenberg, M., Wa-liszewski, M., Chin, K., et al. (2019) Prospective, Large-Scale Multicenter Trial for the Use of Drug-Coated Balloons in Coronary Lesions: The DCB-Only All-Comers Registry. Catheterization and Cardiovascular Interventions, 93, 181-188. [Google Scholar] [CrossRef] [PubMed]
[8] 张闻多, 于雪, 季福绥. 《药物涂层球囊治疗冠心病最新专家共识》解读[J]. 中国临床医生杂志, 2020, 48(8): 901-902.
[9] Muramatsu, T., Kozuma, K., Tanabe, K., et al. (2023) Clinical Expert Consensus Document on Drug-Coated Balloon for Coronary Artery Disease from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovascular Intervention and Therapeutics, 38, 166-176. [Google Scholar] [CrossRef] [PubMed]
[10] Zhang, X., Xu, X., Jiao, X., et al. (2013) The Effects of Glucose Fluctuation on the Severity of Coronary Artery Disease in Type 2 Diabetes Mellitus. Journal of Diabetes Research, 2013, Article ID: 576916. [Google Scholar] [CrossRef] [PubMed]
[11] Cuman, M., Zivelonghi, C., Benfari, G., et al. (2017) Drug Coating Bal-loon: Long-Term Outcome from a Real World Three-Centers Experience. European Heart Journal, 38, ehx493. [Google Scholar] [CrossRef
[12] Tonding, S.F., Silva, F.M., Antonio, J.P., et al. (2014) Adi-posity Markers and Risk of Coronary Heart Disease in Patients with Type 2 Diabetes Mellitus. Nutrition Journal, 13, Article No. 124. [Google Scholar] [CrossRef] [PubMed]
[13] Richelsen, R.K., Overvad, T.F. and Jensen, S.E. (2016) Drug-Eluting Balloons in the Treatment of Coronary De Novo Lesions: A Comprehensive Review. Cardiology and Therapy, 5, 133-160. [Google Scholar] [CrossRef] [PubMed]
[14] Buccheri, D., Lombardo, R.M. and Cortese, B. (2019) Drug-Coated Balloons for Coronary Artery Disease: Current Concepts and Controversies. Future Cardiology, 15, 437-454. [Google Scholar] [CrossRef] [PubMed]
[15] Meneguz-Moreno, R.A., Ribamar Costa Jr., J. and Abizaid, A. (2018) Drug-Coated Balloons: Hope or Hot Air: Update on the Role of Coronary DCB. Current Car-diology Reports, 20, Article No. 100. [Google Scholar] [CrossRef] [PubMed]
[16] 陈韵岱, 王建安, 刘斌, 等. 药物涂层球囊临床应用中国专家共识[J]. 中国介入心脏病学杂志, 2016, 24(2): 61-67.
[17] Jeger, R.V., Eccleshall, S., Wan Ahmad, W.A., et al. (2020) Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group. JACC: Cardiovascular Interventions, 13, 1391-1402. [Google Scholar] [CrossRef] [PubMed]
[18] 陶苑茹, 张晓燕. 药物涂层球囊治疗冠状动脉支架内再狭窄临床试验方案中入选、排除标准的探讨[J]. 医疗卫生装备, 2020, 41(6): 85-89.
[19] Elgendy, I.Y., Mahmoud, A.N., Elgendy, A.Y., et al. (2019) Meta-Analysis Comparing the Frequency of Target Lesion Revascularization with Drug-Coated Balloons or Second-Generation Drug-Eluting Stents for Coronary In-Stent Restenosis. The American Journal of Cardiology, 123, 1186-1187. [Google Scholar] [CrossRef] [PubMed]
[20] 唐殿龙, 范春雨, 李哲. 药物涂层球囊治疗冠状动脉支架术后再狭窄的研究进展[J]. 中西医结合心脑血管病杂志, 2022, 20(12): 2210-2212.
[21] Hu, H. and Shen, L. (2021) Drug-Coated Balloons in the Treatment of Acute Myocardial Infarction (Review). Experimental and Therapeutic Medicine, 21, Article No. 464. [Google Scholar] [CrossRef] [PubMed]
[22] Scheller, B., Hehrlein, C., Bocksch, W., et al. (2008) Two Year Fol-low-Up after Treatment of Coronary in-Stent Restenosis with a Paclitaxel-Coated Balloon Catheter. Clinical Research in Cardiology, 97, 773-781. [Google Scholar] [CrossRef] [PubMed]
[23] Unverdorben, M., Vallbracht, C., Cremers, B., et al. (2009) Paclitaxel-Coated Balloon Catheter versus Paclitaxel-Coated Stent for the Treatment of Coronary in-Stent Restenosis. Circulation, 119, 2986-2994. [Google Scholar] [CrossRef
[24] Byrne, R.A., Neumann, F.J., Mehilli, J., et al. (2013) Paclitaxel-Eluting Balloons, Paclitaxel-Eluting Stents, and Balloon Angioplasty in Patients with Restenosis after Implantation of a Drug-Eluting Stent (ISAR-DESIRE 3): A Randomised, Open-Label Trial. The Lancet, 381, 461-467. [Google Scholar] [CrossRef
[25] 汪志新, 孟宪亮, 张林. 药物涂层球囊在冠状动脉小血管病变中的应用[J]. 国际心血管病杂志, 2023, 50(1): 1-4.
[26] Sanz Sanchez, J., Chiarito, M., Cortese, B., et al. (2021) Drug-Coated Balloons vs Drug-Eluting Stents for the Treatment of Small Coronary Artery Disease: A Meta-Analysis of Randomized Trials. Catheterization and Cardiovascular Interventions, 98, 66-75. [Google Scholar] [CrossRef] [PubMed]
[27] 王亚玲, 饶明月, 郭安君, 等. 药物球囊治疗冠状动脉小血管病变的效果和不良反应观察[J]. 河北医科大学学报, 2022, 43(5): 517-520.
[28] 冯蕊涵. 药物涂层球囊治疗急性心肌梗死患者的临床效果分析[D]: [硕士学位论文]. 郑州: 郑州大学, 2021.
[29] 汪烈武. 药物涂层球囊在冠状动脉小血管病变中的有效性和安全性研究[D]: [硕士学位论文]. 芜湖: 皖南医学院, 2022.
[30] 陈韵岱. 药物涂层球囊在冠心病介入治疗中的应用现状[J]. 中国心血管杂志, 2020, 25(2): 101-103.
[31] 侯斌超, 张燕, 郭艳歌, 等. 冠状动脉原位大血管病变患者药物涂层球囊成形术后靶血管再狭窄危险因素分析[J]. 中华实用诊断与治疗杂志, 2023, 37(2): 147-151.
[32] Yu, X., Ji, F., Xu, F., et al. (2019) Treatment of Large De Novo Coronary Lesions with Paclitaxel-Coated Balloon Only: Results from a Chinese Institute. Clinical Research in Cardiology, 108, 234-243. [Google Scholar] [CrossRef] [PubMed]
[33] Rosenberg, M., Waliszewski, M., Krackhardt, F., et al. (2019) Drug Coated Balloon-Only Strategy in De Novo Lesions of Large Coronary Vessels. Journal of Interventional Cardiol-ogy, 2019, Article ID: 6548696. [Google Scholar] [CrossRef] [PubMed]
[34] 陈群, 王砚青, 徐彧, 等. 药物洗脱球囊处理冠状动脉分叉病变分支血管的荟萃分析[J]. 中国介入心脏病学杂志, 2022, 30(12): 930-939.
[35] Lassen, J.F., Albiero, R., Johnson, T.W., et al. (2022) Treatment of Coronary Bifurcation Lesions, Part II: Implanting Two Stents. The 16th Expert Consen-sus Document of the European Bifurcation Club. EuroIntervention, 18, 457-470. [Google Scholar] [CrossRef
[36] Ferenc, M., Ayoub, M., Büttner, H.J., et al. (2015) Long-Term Out-comes of Routine versus Provisional T-Stenting for De Novo Coronary Bifurcation Lesions: Five-Year Results of the Bifurcations Bad Krozingen I Study. EuroIntervention, 11, 856-859. [Google Scholar] [CrossRef
[37] 许胜胜, 庞玉琦, 刘剑雄. 药物涂层球囊在冠状动脉分叉病变中的应用研究进展[J]. 西部医学, 2023, 35(3): 466-468.
[38] Schulz, A., Hauschild, T. and Kleber, F.X. (2014) Treatment of Coronary de Novo Bifurcation Lesions with DCB Only Strategy. Clinical Research in Cardiology, 103, 451-456. [Google Scholar] [CrossRef] [PubMed]
[39] Bruch, L., Zadura, M., Waliszewski, M., et al. (2016) Results from the International Drug Coated Balloon Registry for the Treatment of Bifurcations. Can a Bifurcation Be Treated without Stents? Journal of Interventional Cardiology, 29, 348-356. [Google Scholar] [CrossRef] [PubMed]
[40] Kleber, F.X., Rittger, H., Ludwig, J., et al. (2016) Drug Eluting Balloons as Stand Alone Procedure for Coronary Bifurcational Lesions: Results of the Randomized Multicenter PEPCAD-BIF Trial. Clinical Research in Cardiology, 105, 613-621. [Google Scholar] [CrossRef] [PubMed]
[41] Lassen, J.F., Burzotta, F., Banning, A.P., et al. (2018) Percutane-ous Coronary Intervention for the Left Main Stem and Other Bifurcation Lesions: 12th Consensus Document from the European Bifurcation Club. EuroIntervention, 13, 1540-1553. [Google Scholar] [CrossRef
[42] 张明超, 鲁大胜. 药物洗脱球囊在原位血管病变中的应用研究进展[J]. 中西医结合心脑血管病杂志, 2020, 18(19): 3226-3229.
[43] Jang, W.J., Yang, J.H., Choi, S.H., et al. (2015) Long-Term Survival Benefit of Revascularization Compared with Medical Therapy in Patients with Coronary Chronic Total Occlusion and Well-Developed Collateral Cir-culation. JACC: Cardiovascular Interventions, 8, 271-279. [Google Scholar] [CrossRef] [PubMed]
[44] Kolh, P., Windecker, S., Alfonso, F., et al. (2014) 2014 ESC/EACTS Guidelines on Myocardial Revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the Special Contribution of the European Association of Percutane-ous Cardiovascular Interventions (EAPCI). European Journal of Cardio-Thoracic Surgery, 46, 517-592.
[45] Basavarajaiah, S., Latib, A., Hasegawa, T., et al. (2013) Assessment of Efficacy and Safety of Combining “Paclitaxel” Eluting Balloon and “Limus” Eluting Stent in the Same Lesion. Journal of Interventional Cardiology, 26, 259-263. [Google Scholar] [CrossRef] [PubMed]
[46] 张文远. 侧支循环程度不同的前降支慢性完全闭塞病变血运重建的预后观察[D]: [硕士学位论文]. 郑州: 郑州大学, 2021.
[47] Onishi, T., Onishi, Y., Kobayashi, I., Umezawa, S. and Niwa, A. (2019) Drug-Coated Balloon Angioplasty for de Novo Small Vessel Disease Including Chronic Total Occlusion and Bifurcation in Real-World Clinical Practice. Cardiovascular Intervention and Therapeutics, 34, 139-148. [Google Scholar] [CrossRef] [PubMed]
[48] 沈珠军. 药物涂层球囊在急性心肌梗死介入治疗中的应用[J]. 中国临床医生杂志, 2020, 48(8): 887-889.
[49] 张峰, 陈欣. 药物涂层球囊在冠状动脉大血管原发病变中应用的研究进展[J]. 临床心血管病杂志, 2020, 36(10): 961-964.
[50] Vos, N.S., Fagel, N.D., Amoroso, G., et al. (2019) Paclitaxel-Coated Balloon Angioplasty versus Drug-Eluting Stent in Acute Myocardial Infarction: The REVELATION Randomized Trial. JACC: Cardiovascular Interventions, 12, 1691-1699. [Google Scholar] [CrossRef] [PubMed]
[51] Scheller, B., Ohlow, M.A., Ewen, S., et al. (2020) Bare Metal or Drug-Eluting Stent versus Drug-Coated Balloon in Non-ST-Elevation Myocardial Infarction: The Randomised PEPCAD NSTEMI Trial. EuroIntervention, 15, 1527-1533. [Google Scholar] [CrossRef
[52] Mehran, R., Dangas, G.D., Kobayashi, Y., et al. (2004) Short- and Long-Term Results after Multivessel Stenting in Diabetic Patients. Journal of the American College of Cardiology, 43, 1348-1354. [Google Scholar] [CrossRef] [PubMed]
[53] Berry, C., Tardif, J.C. and Bourassa, M.G. (2007) Coronary Heart Disease in Patients with Diabetes: Part II: Recent Advances in Coronary Revascularization. Journal of the American Col-lege of Cardiology, 49, 643-656. [Google Scholar] [CrossRef] [PubMed]
[54] 王建民, 程翠婷, 邢亮亮, 等. 支架内再狭窄与药物球囊的认识[J]. 河南医学研究, 2021, 30(24): 4608-4610.
[55] 汤克虎, 高峻峰, 任尽平. 药物涂层球囊在糖尿病患者冠状动脉小血管病变治疗中的应用研究[J]. 陕西医学杂志, 2019, 48(4): 432-434.
[56] Pan, L., Lu, W., Han, Z., et al. (2021) Clinical Outcomes of Drug-Coated Balloon in Coronary Patients with and without Diabetes Mellitus: A Multi-center, Propensity Score Study. Journal of Diabetes Research, 2021, Article ID: 5495219. [Google Scholar] [CrossRef] [PubMed]
[57] 李景锋, 赵玉娟. 糖尿病多支病变在介入治疗中的研究进展[J]. 心血管病学进展, 2019, 40(3): 425-428.
[58] Kleber, F.X., Schulz, A., Waliszewski, M., et al. (2015) Local Paclitaxel Induces Late Lumen Enlargement in Coronary Arteries after Balloon Angioplasty. Clinical Research in Cardiology, 104, 217-225. [Google Scholar] [CrossRef] [PubMed]
[59] 李锦爽, 王万虹, 周浩, 等. 药物洗脱球囊治疗糖尿病伴复杂冠状动脉病变的临床效果[J]. 介入放射学杂志, 2019, 28(8): 770-772.
[60] 周明锴, 刘小军, 张丹丹, 等. 药物洗脱球囊与药物洗脱支架治疗合并糖尿病冠状动脉小血管病变的疗效对比[J]. 心肺血管病杂志, 2020, 39(12): 1420-1423.
[61] Latib, A., Colombo, A., Castriota, F., et al. (2012) A Randomized Multicenter Study Comparing a Paclitaxel Drug-Eluting Balloon with a Paclitaxel-Eluting Stent in Small Coronary Vessels: The BELLO (Balloon Elution and Late Loss Optimization) Study. Journal of the American College of Cardiology, 60, 2473-2480. [Google Scholar] [CrossRef] [PubMed]
[62] 李成洋, 陈宏. 冠状动脉内超声指导下紫杉醇药物涂层球囊用于治疗冠状动脉狭窄26例近期临床疗效[J]. 临床心血管病杂志, 2018, 34(1): 27-29.
[63] 王文彬. 急性冠脉综合征患者应用药物球囊治疗的短期安全性和有效性[D]: [硕士学位论文]. 广州: 南方医科大学, 2021.